Provider Demographics
NPI:1992070924
Name:REDWOODS RURAL HEALTH CENTER, INC
Entity type:Organization
Organization Name:REDWOODS RURAL HEALTH CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-923-2783
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560-0769
Mailing Address - Country:US
Mailing Address - Phone:707-923-2783
Mailing Address - Fax:707-923-1688
Practice Address - Street 1:321 5TH ST.
Practice Address - Street 2:
Practice Address - City:ALDERPOINT
Practice Address - State:CA
Practice Address - Zip Code:95511
Practice Address - Country:US
Practice Address - Phone:707-923-2783
Practice Address - Fax:707-923-1688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDWOODS RURAL HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000099261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235206087OtherRRHC MAIN SITE MEDI-CAL NPI